i would say that this is not just a problem with for protection purposes and it's not a new problem that the government, country has faced. i mean, there was a -- a case of new jersey and new york, new york trying to restrict shipping god across the hudson river from new jersey and the 18120s as a famous supreme court case with that with regard made it clear the federal government has a authority to regulate it and step in and prevent states from takes actions that are directly in that fashion. i think the agricultural committee very much has the opportunity carefully limiting this to agricultural products to

be able to impose this reck nice that the federal government has the authority here and that agricultural products produced in other state that may meet these particular standards can't be restricted from getting access to those states. if we don't take a strong stance at some point, the gentleman of california is correct we will see it proliferate. if we take a strong stands states will find outs it's to the economic disadvantage to do this and the agricultural activity will float states that don't have the excessive regulations and therefore, i think that will be a discouraging factor. not just in other states but the california itself to send a strong message you can't regulate interstate commerce by passing rules like the one that was passed by initiative and referendum in california with

regard to egg production. again, i strongly support moving forward with this amendment, and i urge my colleagues to vote for it. >> gentleman yield back the time. gentleman yields back his time. i believe the gentleman from kansas would like to strike the last word. >> thank you. i move to strike the last world. >> recognized for two minutes. >> to my colleague from iowa. i thank you for yielding. point out the amendment references -- which you all have memorized by heart. it's a list agricultural product. it stays i believe specifically within the jurisdiction of the commie. i wrote an original bill to all the products so you could address with steel and other items brought it specifically so it would be in order in the committee. however much the gentleman from

oregon will meant missing missing that opportunity i don't believe it would have succeeded in the end. but i will say that gentleman from california made my point when he said we have to be able to figure how to compete. and that is what is going on. it's trade protection within some of the states so that there's a competitive or comparative advantage for the producers within the state that ends up lacking out products from other states or compelling the producers from the state to adapt to a means of production which inefficient and meets the political ideology of california for example and ohio being another state like that. referendum in the democratic process from the gentleman from oregon mentioned. i don't think it's democratic to have a state like oregon or california or any or state dictate to the rest of the country how they produce their ag products as far as the jurisdiction is concerned, again, it's narrowed to the egg committee. i serve on the judiciary committee along with

mr. goodlatte i thank him for the amendment on the e amendment. i have no qualms what kind of pushback we get. i'm comfortable what we've done. some said we should provide a solution, i have work on this a long time. thing is the solution. i think it's actually the solution for california's troubles to. and just think if it had been five years ago had been enacted law we wouldn't be having this conversation today. i thank the gentleman from kansas and i yield back to him. >> gentleman yields back. seeing a request for recognition from the gentleman from indiana. >> move to strike. >> recognized for two minutes. >> thank you. i know, it's late. it's probably one of the most important amendments we may consider this evening. because this has huge ramification for trade among the state. coming from northeast indiana we have a large egg production

plants in northeast indiana. their concern this is going to effect every state around the country because california is such a large consuming state and this is going to start creating a backlog of egg producers. they have eggs they can't do anything with because their egg goes to california, idaho eggs go to california. it's going create a wave across the country that just cannot be handles by the egg producers. i think this amendment that mr. kink has put together is the fix because we have looked at several other ideas to try to meet the problem that we all face because we count on california to be that consumer of the products that we raise in throwt the rest of the country. and so i think this is a great fix not only for the rest of the country but also for california.

where we as a agricultural committee can step in and as we focus on agricultural issues, we can say this is important not only to commerce but also to agricultural around the country, and this is a win-win for both california and for the rest of the country. i appreciate mr. king's work on it. thank you mr. chairman, i yield back. >> gentleman yields back. seeing any asian additional recognize? none. we proceed to vote on amendment number 45. all those in favor of amendment number 45 will signify by saying aye. all those opposed will respond by saying no. no. it appears that the ayes have. it it appears that i ayes have. they have it. amendment number 45 is adopted. i would alert my friends we now at 13 hours and 5 minutes into

the process, have only 14 more amendments to go. the gentleman from iowa is recognized. what the purpose? >> gentleman has amendment at defects. would you state the number, please. >> amendment number seven. will the clerk distribute -- 70. >> yeah. >> 70. will the clerk distribute amendment number 70 and the gentleman is recognize for two minutes to explain it when he's ready. >> thank you mr. chairman, this is myself and congressman gibson and together we have about fort years of army time between us. i appreciate would like to yield to him whenever he'd like to be a part of. a couple of tours in vietnam and nato and i understand. i understand the call to serve i'm aware of the setbackst return home seeking jobs.

like many other farmers, i returned to evolving world full of changes and capital and technology that completely altered the way farmers. i survived after some real struggles on the farm crisis of the 1980s with the help a local cooop and the bank and friends. today technology changes even more frequently and more quickly than ever before. this is why our veterans deserve access to lay yai son who can connect them with the resource and training they need. who understand the skills and perspective that veterans bring to farming. amendment number 70 supported by national sustainable agricultural collision would establish a position within usada to assist returning veterans and 0 a advocate on their behalf within the department remembering that the department the agricultural second only to the defense in size. this provision would ensure

veterans are knowledgeable about existing u.s.d.a. programs they are eligible for and able to benefit from this pep it would be empowered to work with veterans affair to coordinate veteran benefits with enrolling agricultural training programs. i seek your support and i hope that mr. gibson might seek time. >> gentleman yields back the time. gentleman from new york seek. gentleman recognize for two minutest. >> i want to thank my colleague for his career and also for the leadership on this issue. and it's a privilege and honor to be working with him on this. i see it initiative as related to couple other very important efforts that i'm involved with, you know, one with the couple farmers back home. young farmers coalition that are trying to get next generation of american into the farm including

veterans. and then also a initiative that i'm working with representative to try to better reintegrate our returning service men and women when they come back home ton the community. ic it's an important step forward to help with the situation awareness education and training for advocacy for veterans. so they take up the cause that -- of farming. so i urge. my colleagues to support it. thank you. i yield back. >> gentleman yields back. the chair strikes the last word and recognize himself for two minutes. simply notes i believe this is the good work by both the fine gentleman. i suggest we pass it in prompt way. seeing no other request for recognition. we vote on number 70. all those in favor say aye.

all those say opposed say no. the ayes have it. amendment number 70 is adopted. are there additional -- spin around to the gentleman from texas over here who seeks recognition. >> i vitamin eamentd at the desk. your amendment number is 74. clerk will distribute amendment number 75. recognized for two minutes and may spread with the discrimination of the. >> thank you. as you knowed in the 2008 farm bill, we passed mandatory country labeling. our friends to the north and south did not think that cool was all that cool and they challenged this piece of legislation in the wto, and the ruling with against u.s. on that. and it was a appealed it was lost and now while the ruling

said that the u.s. can keep the cool program it still found the provisions must be changed in order to make the wto compliant. what the amendment does is it just says within ninety days after passage of this legislation effective date, that the secretary shall bring a report as to what their plan is to comply and make the cool wto compliant. very simple and straightforward. i would yield to my good friend mr. scott. >> i move to strike that. thank you mr. chairman. >> recognized two minutes. >> as he pointed out it's very important, very important the beef industry. our cattle industry and pork industry because what happened in that final decision and this was just on june 29th when the wpto -- wto appealed the body upheld the original decision,

they found that even though they ruled u.s. -- we can keep our cool program, it still found that as provision must be to our provision must be changed into cool program in order to be wto compliant. and if we do not become compliant then the wto will allow both canada and mexico to retaliate against the united states. and this is the major issue. we do not need to have mexico or canada retaliating against the united states. our cattle industry, in canada and mexico are both worth over $1 billion and our markets for beef for our prork industry, mexico is the largest value market valued over million dollars. that one example with this retaliation, and that was recently in the mexican trucking issue. and it serves as the most recent example in case there are some who don't think we need to address the issue.

and what happened in that retaliation issue, mexico retaliated with a tariff of 5%. it was imposed by mexico, and exports of our targeted pork products fell as a result of that 10% in the first ten months. and canada exports grew by 64% during the same period. the exportsportsports are low regulartive to the united states export canada export growth is a great concern to the united states pork industry. so it's clear that the canada pork moves to mexico when the united states is faced with retaliation. so this amendment will serve to keep the usda on task while developing a plan to comply with a wto ruling, and will give like stock producers our beef producer, pork producers peace of mind to know that the usda is

working to protect them from retaliation. so we urge a vote why we why on the cool amendment to ensure that america's hog and cattle producers not face retaliation from canada or mexico. >> gentleman's time expired. the chair now notes that the ranking member seeks recognition. >> i move to strike the last word. >> recognized two minutes. >> chairman, members, the u.s.d.a. is going to report to the committee on the necessary steps that the take because the wto ruling. i don't think there's need to put it into the farm bill. they're going to do that. you know, let's give them time to digest what this ruling means and not push some arbitrary deadline that may get a result that might be contrary to what some of the folks are pushing this are trying to do. the ruling found that the united states has the right apply country of origin labels.

that the -- does not restrict trade. so that -- the law was upheld. all they said was that the imported livestock into the u.s. fashioned some disadvantage because of the way usda and the segregating and requiring recordkeeping. so that's the issue. they have to figure out a different way to deal with that or figure how to accommodate that. you know, they're in process of doing it, you know, i don't see any reason why we should put an arbitrary ninety day date on, you know, . >> gentleman . >> do it as soon as they can. >> does the gentleman yield many >> i hope that you're right they are doing it. >> they are. >> so if they're doing it, i don't see any harm of putting this in the farm bill because it just solidifies. >> i don't know if the ninety days work for them or not. that's what i don't know. but, you know, we spent i don't know how many hours negotiating

country wars and labeling. the last farm bill. i finally locked them in a rule over there, and told them they couldn't come out until they got it resolved. they did. if we don't, you know, -- so. >> would the gentleman yield? >> i don't want to get back into that war again. >> you're right, mr. chairman, if you recall, i was one of those you locked in the room. when i was chairman of the livestock committee. you know, and i think your point, you make good points there, but is it asking too much for us to send the message send two messages, one message would be a message for the cattle industry, and the pork industry. they're the ones that have the hooks on the line on this. they're the ones that are concerned. and we've had an experience of

retaliatory for mexico. this is a very sensitive situation and it's not costing us any money. and ninety days is three months. it's a pretty good amount of time. this happened in 2008, in september, 2008. as soon as we put the cool -- the cool labeling on, and a series of things have happened over period of time. it was march when our trade representative appealed this before the board. two weeks ago, june 29th they came out with the decision. i think we don't have many opportune moments like this to really help our industry. this is very critical, and, you know, i essential respect what

you have respect and i respect the work you have done. i was there with you on this, i feel very close to the issue. you made me stay in the room and deal with it until it was done. i respectfully ask that perhaps that we just use this as our opportunity to that our beef industry, our cattle industry and pork industry is very important. when we need to make a stand for them, i think we should. >> gentleman's time is expired. >> gentleman from. >> i strike the last word. >> recognized. >> two minutes. i just -- hearing somewhat i was out of the room hearing what he had to say and others. we went through an ordeal over this. i think come consumers have a right to know and i think most feel that. and those produce don't mind. i hope that we slow down and walk before we run here.

and this slow down a little bit. we don't need to be doing this. >> gentleman yields back the balance of the time. the gentleman from texas seeks recognition. >> i strike the last word. >> recognized. >> thank you. i yield. >> thank you, gentleman. i want to be clear, there is ninety days from enactment. if you think we're going to enact it tomorrow and the clark starts tomorrow. >> i thought we were. >> well, i mean, -- [laughter] >> i think we're giving them plenty of time. i think it gives them deadline. deadlines get missed around here. i think it does send. >> yes the gentleman gleeld glep. >> what happens if survives con friends committee and it's ninety days and they don't produce a report. are you going to be beating them because they miss the deadline? >> we're going to write the secretary a letter and ask why he habit given an answer. >> i think he amaze a good

point. the industry is in limbo until we get . >> are we going to have hearings like on the cftc and hay miss the zillions because they were doing the right thing and call them in and beat them. >> sometimes they don't do the right thing. we don't know whether they'll do the right thing on this or not. >> does the gentleman yield back the balance of him time? >> yes. >> the question before the body. gentleman from kansas is recognized for very brief two minutes. >> i appreciate the indulge of my colleague. cattle producer need certainty. i'm not worried about the usda i'm not worried about the committee or congress. i'm worried about certainty for the cattle producers. adopt the amendment and get the report out there and get an answer. thank you. i yield back. >> yields back the balance of the time. proceed on the amendment number 74. all those in favor of amendment

number 74 signify by saying aye. all those opposed signify by saying no. i'm going to have get hearing aids. it would appear that the noes prevailed. >> mr. chairman, the gentleman . >> i would ask for a record the vote. the clerk will call the roll. [roll call vote]

[roll call vote] [roll call vote]

[roll call vote] [roll call vote]

[roll call vote] mr. chairman, the vote is 34 aye-12nays. mr. chairman we have an amendment at side desk number 84. the amendment number 84, the

gentleman may proceed with the explanation. i recognize for two minutes. >> thank you i'm joined on the amendment by colleagues representative owens and pennry. this is a maple amendment that would , by the way, maple sugaring are is an important supplemental activity for many farmers and mine in other state paps lot of dairy farmers use them. they supplemental north carolina they -- they get from maple syrup made a difference in the survival and sustainability. what the secretary of agricultural to issue grants for research and promotion of maple sur sur rupp, some of the thing that happen at university of vermont they did research on this, they came up with a new

tap that was much more successful in getting more sap out of the tree and more maple super production for the farmers. that's getting extremely important we've had some weather changes in the v. vermont area. providing the secretary with authority to issue the grants will keep vermont farms and other farms around the country that have maple production as a serious supplement tal component to the income in business. i ask my colleagues, and representative 0 owens join me in this. ask our colleagues to support the amendment. thank you, mr. chairman, and i yield back. >> go ahead. >> the gentleman yields back. the gentleman from new york seeks recognition. >> strike the last word. >> recognize for two minutes. >> recognizing it's important all of our communities, i think that the first thing we should note is that this will allow new

york state to take over the rightful place as the leader in maple production in the united states. thank you, i yield back. [laughter] >> so you a friend there, sir. does anyone wish to comment on the amendment? >> mr. chairman. >> gentleman from texas. >> recognized. >> strict last word. >> recognized for two minutes. >> thank you. certainly love maple syrup just like i'm a keen fan of organic apples. [laughter] but i've got ask, is there appropriates $20 million a year for physical -- six years out of $20 million. are you taking this money out of somebody's hide or is it new money on top of what we're already spending? >> as you know, if there's any appropriation, it's going have comply with the house cut-go

rules that are enforced. this is something that would have to be worked out with the appropriators. >> well, but i do think is this is new program, and as i talked to my colleague from california, respect to hispanic schools and scholarships, i'd be sympathetic to this if we had a specific place saying we're not going spend money somewhere else because it's a new program. and it doesn't help the appropriators prioritize the way we should be doing this prioritization on this bill. i'll be opposed to the amendment, sir. >> if the gentleman will yield. it's a fair point. we're in a bit of a situation here where with the cut-go requirements, you may offer a good idea, another member may offer a good idea in a committee that has authorizing authority but not appropriating authority.

..

>> the chair would strike the last word and ever so briefly noted that while i understand mr. connolly's point i do appreciate the effort the gentleman is trying to pursue. seeing nonetheless proceeded to vote on amendment number 84. all those in favor of amendment 84 will signify by saying aye. all those opposed to signify will say no. >> amendment number 84 stops. >> gentleman from texas ask for a recorded vote on amendment number 84. the clerk will call the roll. >> mr. goodlatte [roll call vote]

>> noes [roll call]

[roll call] [roll call] [roll call]

[roll call vote] [roll call vote]

[roll call vote] mr. chairman devotees 25 yays and 17 nays.

>> the chief recognition. >> i have an amendment numbered 11 at the desk. >> mr. chair, i would like to raise the point of order. >> the gentleman rivas serves the point of order recognized for an explanation. you may proceed. >> i ask unanimous consent to strike the last word. >> repeat that amendment 1 more time. >> 11. >> amendment number 11 has been reserved. >> recognized for two minutes explaining how to explain the amendment. >> very good. this is a bipartisan amendment supported and co-sponsored by over 80 members of the committee and i think everyone for their support. it's designed to save taxpayers' dollars by eliminating a duplicative program while at the same time ensuring american farm commodities are not put in risk

by a potential trade war with vital trading partners. they propose catfish inspections of the fda to the usda. this move was inserted in the 2008 farm bill during the conference without open debate and has caused problems for implementation after four years the program has not yet been established. the gao says it would cost $30 million initially to set up with $15 million every year thereafter. the rest of the agriculture industry and putting the association believes it is on an unnecessary program to violate the wto agreement and jeopardize an agricultural economic recovery. the government accountability office and independent nonpartisan government issued a report i have a copy of your entitled seafood safety, responsible for inspecting catfish should not be assigned to the usda.

the agricultural commodity groups and individual companies have expressed concerns that creating duplicative inspection programs may start a trade war with our vital trading partners at almost every u.s. commodity organizations submitted comments opposing the inspections to the usda when the rule was published. this amendment supported against the firm at least, the national restaurant association and a former usda undersecretary for food safety and others. opponents claim that this will provide zero savings to the taxpayer but in fact the only way the cbo was able to score that is because they believe the program would never be implemented. it was implemented the gao estimates would cost $30 million initially to higher as 90 new inspectors and cost $40 million every year after work to implement. currently fda inspects all fish at $700,000 a year. this usda program if it were to

be implemented would cost 20 times more than the fda per year. repealing the usda to fish inspection program as a common sense approach to food safety, it promotes open trade, the u.s. agriculture exports and the wide use of tax dollars stopping the misuse and waste for precious tax dollars. june 19th the senate adopted a bipartisan amendment offered by senator john mccain and john kerry by voice vote. not a single senator objected during the vote. i hope the house can do the right thing and repeal the wasteful government program on a bipartisan basis tonight. thank you and i urge support and yelled back. islamic the gentlelady yields back. does the gentleman insist on a point of order? >> i thought it was going to be number ten that number 11 was brought up. >> the gentleman with draws his point of order. does anyone seek recognition to discuss this amendment.

we passed this in 2008 in the good policy then and good policy now and we should stick with it allotting the usda to go through the rulemaking process is what we should do with industry and put so they get it right. it is not duplicative. the inspector is shipped in from the usda and usda oversees many of the activities now frankly in my opinion of the fda should have never been given authority over food safety. we should have kept that in the first place and we would have a lot better situation in this country. so, if i have my way we would take all the inspections away from the fda and put it to the usda. sway very strongly support the current policy and i am opposed to this amendment and i would yield to mr. crawford if he

wants time. >> i would appreciate that from the ranking member and at the gentlelady's amendment to the usda catfish inspection the committee recognized exactly what is at stake americas safe and reliable food supply and the gentle lady from azeri attending the shengjin discussion and food safety to totally on granted debate on duplicative regulation trade barriers as conservative member from the district there's nothing more than i would like to do than describe the duplicative regulations in this now various free trade getting rid of the usda catfish program however does neither. first it's not to put it as a ranking member indicated catfish inspection to be transferred from one agency to the other. the trade partners play on a level playing field and the main issue explains why the usda inspection program is so critical for food safety and advocates completely ignore the danger posed by those substances which have been discovered in the shipments of catfish or as they call them catfish.

the refusal to import alert some investigation showed the band drug chemicals were discovered in fish imported from vietnam and china. even the fda deputy commissioner for the international special programs testify before the senate committee in 2007 saying the use of the u.n. approved an ally of exhort chemicals in the raises significant health concerns. he went on to say the fda found an approved new animal drugs and unsafe additives 25% of the samples from china as a parisian them from the alabama the provider culture and investors examples of catfish and from china, vietnam, cambodia, indonesia and thailand found that one in every three of the fish tested positive for harmful and by audits that are not approved on the wto vital century standards. why learn from the research of dr. carol ingalls the department of university arkansas half of the food is said to the vietnamese fish is homemade without any monitoring eliminate the use of harmful chemical weapons and drugs the pictures

in vietnam where you can see in our house where human waste is released directly into the water on catfish farms pretty shocking stuff even the vietnamese agriculture it will but admitted in november 2009 with the difficulties and monitoring and managing the quality of see it, and fish product. the truth is the river is polluted with sewage and toxic chemicals. we are importing more and more catfish every year in the conditions that i just illustrate. if the fda was doing its job before the farm bill was passed to be no need to switch over, but the truth of the matter is they were not doing their job and the usda is capable of testing about 3% of the products. the usda to fish program cannot as a result of the data and concerns i just laid before you. the catfish industry asked for the inspections program which is stricter than the program they had in the fda. the gentleman yields back. the gentleman from iowa seeks

recognition. the gentleman is recognized. mr. king and i and others have some idea since i saw the vietnamese product in '65, '66 and 69 and guess what it had not changed i would defeat this amendment and i would yield to mr. kaine nor mr. goodlatte just on the trip. >> the gentleman yields back and i have a request recognition from the gentle lady from alabama and then followed by. thank you in an effort -- >> the gentlelady strikes the word for two minutes. >> in an effort to not be duplicative i won't go for the

arguments that have already been made but we have a situation where the priest concerns about public safety and then we give confirmed that this amendment doesn't save the taxpayer 1 penny and i have to ask why the cat fish inspection program was created so much opposition. well, it appears the seafood importers of what the opposition to the usda catfish inspection and to be honest i can understand why the opposition would be so relentless according to the fda testimony that 80% of the seafood in the country is imported from approximately 130 countries, and as i stated, we already know that for the fiscal year 2009 the fda tested on the about .1% of all imported seafood from the job of. they naturally as doubles and implemented cash for inspection and in general members of this committee how we move forward to pick out the four bills in such burdens and i would like to highlight that supporting this

amendment it cannot improve our food safety system and the usda should finalize the inspection rules. this amendment is agreed to the committee is actually telling the usda to not even finalize the rules and regulations for the usda cut fish inspection and find it interesting members of the committee will support that has not been finalized by the industry and it doesn't save the taxpayer 1 penny. i urge my colleagues to oppose this amendment and i yield back to the estimate that gentlelady is recognized for two minutes. >> thank you mr. chair. i would strike the last word. i respectfully would like to associate myself with the ranking member peterson as was all the other speakers who spoke in today including my esteemed colleague from alabama,, ruby. i believe that we should oppose this amendment. i think that this is more about

food safety and the health of the american public. i won't repeat what everyone else has said but i think it's important to note and to remember that the cbo has scored zero savings, and yet since the implementation in 2008, we correctly gave the inspections authority the usda and we have allowed them to promulgate regulations directly enforce that inspection which is why i believe that we continue to see contamination from imported catfish throughout the system. so, i urge my colleagues to vote no on this amendment. >> with the gentlelady yield to the chair? to quick thoughts. fiscal year 2005 to 2010 the fda inspector on average 844 and seafood processing facilities and we all of the 17,000 worldwide. fda inspection lacking here at

home half of all domestic cat fish plants the estimated five or ten years without an inspection. i yield back the gentlelady that yields back. seeing the no other. >> the gentleman from indiana seeks recognition. the gentleman is recognized for two minutes. >> i have to speak up in support of this amendment. i do agree with the ranking member that the usda should be doing all of the inspection, and i think that that is why this amendment is appropriate. let's start over. whatever happened back in 2008i wasn't here. i don't know exactly what happened, but i think that the appropriate thing to be what start over and make sure the we don't have to programs during the move forward. the usda indicated they would need to spend approximately $30 million to support the program. once they do they to spend

$30 million is that the program and at least 15 million a year to fund over 90 new government inspectors. i've spoken with mr. crawford jian-li agree with the intent we all have the same goal but for us to make sure that we get the right i think we need to support this amendment and go and start over and make sure the jurisdiction is transferred over the usda because if we let them continue to get their fingers and they are always going to fight to keep their fingers into that in the inspection programs, and i and that they are granted the right and i would ask for your support of the committee for its amendment. think you and i yield back. >> the gentleman's time is expired. thank you. seeing no other. >> the gentlelady seeks recognition. the gentlelady is recognized for

two minutes. >> with all due respect for the last speaker, we did get their right in 2008 when the farm bill and all of us voted in favor of getting the inspection rights to the usda. now it's time to let them do their job and inspect. i think that what is happening is that many of the processors and all the people who were opposing this were in favor of this amendment are in favor of allowing imports to help process. which we should be focusing on as the health and safety of the american people. we want to make sure that we are eating cafeteria and fatiguing catfish and that is the key and then supporting a leveling the playing field is one of the issues. it's unfair that there's a different standard for imports than for domestic catfish so we should level the playing field and oppose this amendment.

islamic all of those in favor of the amendment number 11, signify by saying aye. all those opposed, signify by saying no. it appears the nose have it. the noes do indeed have it. >> the gentlelady has requested the role to be called. >> with the clerk please call the roll. >> mr. goodlatte? >> mr. johnson? >> mr. king? [roll call vote]

[roll call vote] [roll call vote] [roll call vote]

[roll call vote] [roll call vote]

[roll call vote] [roll call vote]

[roll call vote] >> mr. chairman, devotees 20 yays, 25 nays. >> amendment number 11 is not adopted are there additional amendments as well? >> the clerk will distribute just one second the gentleman reserved the point of order and recognize the explanation. >> thank you. this is amendment relates to the

sugar trade between the united states and colombia. this will simply clarify the rules governing the trade between the united states and colombia. under the recently finalized and passed and signed united states colombia free trade agreement the goals in the united states and colombia negotiators of the agreement and establish essentially the same rules under the agreement applies to the capitol. with this amendment does is simply provides that the united states exports of sugar to columbia would be dependent on the united states becoming a net exporter of such exports would be the united states content sugar. this is a win-win for the united

states and colombia and sugar growers because it would require exporters to use united states produced sugar and exports to columbia of a free trade agreement interest and would prevent the columbia market and would be flooded with mexican and other third country sugar trans shipped through the united states and further this proposal would not have any effect on the united states sugar price support or supply management programs, nor would it have any effect on the budget. this is a piece of legislation that respect the united states sugar industries.

while i urge my colleagues to review this amendment very carefully, i understand that there are parliamentary concerns about. i want to give it time for us to give thoughts to this proper and so i will withdraw it today, and i know mr. conaway is pleased to hear that a very good step and a dialogue that is needed and other committees of jurisdiction on how to make sure that this much needed clarification of the free trade agreement is achieved whether that be through legislation or of the ministry of action is certainly is an issue that deserves certainly our concentrated and immediate

attention. unanimous consent see no objection the end that is withdrawn therefore i assume the gentleman will vacate the order. >> absolutely. that amendment is disposed of. are there additional amendments to the title 12? >> mr. chairman? >> a gentlelady from south dakota seeks recognition. >> thank you pittard i have an amendment at the desk, number 82. >> the clerk will distribute amendment number 82. and with my due diligence i'm going to look at 82. >> thank you mr. chairman. this amendment was -- an office of troubled relations within the office of the secretary of the agriculture with the usda. this would help facilitate a

vindication between tribes against the united states with the department of the agriculture helping them recognize and understand options and opportunities there would be available to them through the usda programs and ensure coordination and it also recognizes the importance of the government to government relationship that we share. i believe it is a common sense amendment similar to one we've had earlier in the section and i would ask for everyone's support on the amendment 82. with that i will yield dhaka. >> coming from a state that has cultural diversity pittard i would suggest we amend 82 and yield back to the gentlelady i would assume would yield back to the chair. >> i do appreciate that, and also i did want to mention that this is a provision that was accepted in the senate version of the farm bill so we would be

staying consistent with the adoption as well. with about i would yield back. >> to vote on amendment number 82 all in favor of amendment 82 signify by saying aye. opposed signify by saying no. ayes have it and it is adopted. are there additional amendments on the title xii? >> let's go to the gentleman on the front row mr. mcgovern seeks recognition. the gentleman deserves a point of order. >> number 32. >> the clerk will distribute amendment number 32, and the gentleman is recognized for two minutes to explain his amendment. >> my simple common sense amendment but close a loophole in the animal fighting law that allows the spectators at the fights to avoid the prosecution. my amendment is modeled after a

bill of pennsylvania has introduced and has 200 co-sponsors, 15 of them on this committee including five republicans. it is endorsed by virtually every major law enforcement organization in the country inherited an illegal animal fighting event the show up often in secret locations and meeting a passport to enter and paid tuition fees and gambling which is to fuel the industry and make it profitable. spectators are more than mere observers have animal fights. they are an integral part of this electricity. these events would not happen without spectators. while 49 states have the walls to allow the arrest and prosecution of spectators there is no provision in federal law prohibiting the attendance of the fights. animal fighters exploit the spectator loophole. we all know animal fighting is in a humane and cruel since 1976 there's been a federal law and

is making it legal to engage in fights to possess animals for fighting or to sell cockfighting implements. each of the prior four bills have included provisions of overwhelming and unanimous bipartisan support to close the loopholes and strengthen penalties related to animal fighting. my amendment refines existing federal law to eliminate the inhumane practices and all fighting and complement to work to the states. we work this language out carefully with the parliament. i don't believe there would be any point of order against it and i would yield back the balance of my time to the chairman to lead us in a rousing and overwhelming unanimous yes votes. i would yield back my time. >> the gentleman yields back his time. i would move to strike the last word. >> both points of order have been vacated. the gentleman is recognized for

two minutes to respect think you mr. chairman. i happen to think about animal fighting is not a good thing. i have supported. we have a federal rule for example when you talk about transporting fighting animals across the state line in the legislation to accomplish that in fact i think i have the razor marks in my back for having supported the legislation in the past but i am opposed to this legislation because i think that the decision about whether or not it should be legal to attend an animal fighting venture is something that is pretty much the purview of the state's and while some might go across the state plans to attend the event primarily it is read the people that are participating in the local then you come and i don't think the congress should assert itself into this issue and pass

an amendment to the law that inject the federal government as something that could be perfectly well handled by state government passing along to deal with who can attend these events in in their particular state so i urge my colleagues to oppose the amendment and i yield back. >> the gentleman yields back. does anyone else seek recognition? >> the gentle lady from maine seeks the recognition. >> one of the reasons we are bringing this to the committee is local law enforcement officials have urged us to do this. there are a large scale animal fighting investigating and prosecuting by federal authorities could sometimes federal involvement is warranted because the local law enforcement in the areas lack

the resources to tackle the problem and so, this is not -- i think anything that the states don't want in fact i have a list of every major law enforcement organization in the country from 46 of the 50 states who signed on to a petition urging that we take action to think it's a responsible thing to do. they shouldn't be controversial we should be able to come together and pass this overwhelmingly by a voice vote i think the gentlelady. >> the gentleman from iowa seeks recognition. >> the gentleman is recognized for two minutes. >> i would like to associate myself with a statement in regard to the spirit i oppose any kind of amol fighting and i believe all of the state's out law in every way of a discussion or debate applicable states that the assumptions and the debate was about the interstate commerce that would have been moving animals across the state lines for the purpose of

fighting. that's fine. that's something we have the jurisdiction to address. this gets into micromanagement i think there's a constitutional question i'm not sure that it's unconstitutional by think it is micromanagement on the part of the congress and should be beyond our perfume and a lot of the states to the regulation the deutsch an adequate job and i recall the narrative of some animal fighting on was allegedly taking place in tennessee when helicopters dropped in and law enforcement officers for every venue and forced whatever provisions they had they were able to rate that fighting in tennessee they can still do that in massachusetts or anywhere else and we would be i think remiss if we didn't notice that there is already many that are not being enforced in the country due to lack of resources the president of the united states claimed his prosecutorial discretion and he can simply wave the enforcement from individuals if he disagrees and the law. he has gone so far as to

establish prosecutorial discretion by executive with four classes of people and grant them a work permit on the authority of the president of the united states. that is supported by an amendment like this we need to pull the reach back. >> the chair would strike the last word and recognize himself for two minutes. i recognize myself for two minutes. >> amol fighting is an atrocity and it's wrong which as i colleagues alluded to that is why it is illegal in every state. that is why it is unlawful under the animal welfare act to sponsor an animal fighting venture. but understand the concerns for the page of the federal authorities and the role.

we are in an economic such rich with limited resources to fulfil the current mission in a more thoughtful and deliberate manner. so for all these reasons i personally must oppose amendment number 32 at this time. >> i struck the last word. >> i respect mr. mcgovern and i think that he's making a very good point, and i think that what i would like to do is yield the balance of my time so that he can clear up his points. mr. mcgovern? >> i thank the gentleman. i wanted to point to my colleagues a similar amendment was introduced by senator vitter over in the senate with 88 to

11. we need this in large part because the law enforcement has asked us for this for the interstate transfer of the animals and parties for multiple states the feds are better suited to handle these cases because of the patchwork state laws. i would conclude if we are all horrified by the animal fighting than they would support this amendment this is one way they should be effective in deterring it in the future. >> the gentleman yields but see no further requests for time. islamic signify by saying aye. >> the clerk will call role on

an amendment number 32. >> mr. goodlatte? mr. king, [roll call vote] [roll call vote] [roll call vote]

[roll call vote] [roll call vote] [roll call vote]

[roll call vote] [roll call vote]

[roll call vote] devotees 26 yays, 19 nays. >> amendment 32 is adopted. are there additional amendments to title 12?

>> the gentleman is recognized for two minutes and may begin his explanation when he is prepared. >> this is a continuation of the policy that was included in the 2008 farm bill. we have a research project for demonstration project where a producer is participating in that but for example any relation he would receive for participating but wouldn't count against pnac let's participating in. this applies to the overall aquifer which is one of the largest in the united states. there's currently a multistate project going on and basically what we want to do is make sure that we continue the policy in 2008 that allows the farmers and

ranchers to participate in the program and not penalize them for doing it because otherwise it would be discouraged for those folks to participate in those programs if the money that they receive to implement some of the research were counted against the payment limits, and with that i -- >> would the gentleman yield? >> the chair would like to note to the support their language. i think we have five or six more to go. i would suggest the gentleman take that to its smile and i yield back the gentleman. >> all those in favor of the amendment number 72 signify by saying aye. all of those opposed? the ayes do have it and the amendment is adopted. i can become operative. are there any additional amendments under title 12? >> the gentlelady is recognized. >> thank you. i have an amendment at the desk is number 52.

>> the clerk will distribute amendment number 52 and the lady is recognized to begin her explanation when she would care to. >> thank you, and i went to first thank the share for working on this amendment and think the ranking member for his assistance and support. this amendment actually started out a little bit larger but during the course of the evening thanks to some negotiating we have shrunk it a little more than i may have wanted to but still appreciate having something i hope can move forward. this issue came to me i know certainly in my state one of the concerns i hear the most from small farmers who are developing their local market there is just not sufficient facilities for water and processing to make the for the eligible to sell retell and in restaurants and in the markets that are developing. and that's why we wrote the bill originally. the amendment originally.

we had more language for the grants to make it possible to go right ahead and to assist. but now in this currently at the department of secretary to report back the and analyzing the scope of the problem, which i assure you will be large i know in my state there is only one certified poultry processing facility for the state as large as ours as very expensive and difficult for small grow worse to have to transport that district. it also has -- requires electronic submission for the label processing. one of the concerns i hear is individual labels have to be made and can take up to six weeks and sometimes more to have approval of the label. it's not standardized in the computerized age it should all be electronic and should be much simpler. i urge everyone to support of this, and i'm sure if you have a

lot small go was in your state receive this great markets you are hearing what i am hearing in that there's not enough facilities. >> with the gentlelady field? you have been cooperative and have worked hard on the amendment and make it an efficient plant. i would urge my colleagues to vote for amendment 52 infield pact let's vote. >> yelled back. all those in favor? de vote will proceed on the amendment 52. all those in favor of amendment 52 signify by saying aye. all those opposed signify by saying no. the guys do have it. number 52 is adopted. is there an additional amendment to title xii? >> thank you mr. chairman putative >> it is a replacement for the king 44 designated as number

334. >> a point of order has been reserved. >> the gentleman reserves a point of order sponsor of the amendment is recognized for his explanation. >> and it came from? >> thank you mr. chairman. this is a replacement amendment, so i suspect that point of order may not apply, but what if this is the language and the intent, and it's been the finding of h.r. 2492. as many of you will know, and i know up and down the missouri river you will know that we had epic floods last summer. we had floods that poured down the missouri river and about 20% more than ever experienced before the corps of engineers had designed the reservoir system upstream to accommodate for the greatest runoff experience the was 18 eda one now we have a greater run off and that is 2011. they have also declared the 2011

to be a five-year rate at which designates it by the corps as an anomaly. we only focus is on a direct for the secretary of the agriculture but i would point out corps of engineers have the resources to protect us from the serious downstream flooding all the way to st. louis. they didn't do that. i don't fault them but i do for not taking the steps to prevent this in the future. but this does is asks and directs the congress of the secretary of agriculture and i'm reading from the amendment to take action to promote immediate increased flood protection for farmers, producers and in the missouri river basin by working within his jurisdiction to support the efforts to recalculate the amount of space within the system that is allocated the flood control under the 2011 flood model, and to increase the channel capacity that in the reservoir upstream and also below gavins point.

so this is a sense of congress that does go direct to the secretary of a culture to promote within its authority. for those that may not have caught this, we have lost 54 miles of interstate 29 closed for three and a half months. 4 miles of interstate the was flat out washed away and millions of trees that are gone and hundreds of thousands of acres covered by sand. it is not any longer trod in the speed of habitat. it never was. now it is a camel habitat sand and dead trees as far as the eye can see. so i have written a full series of letters to the secretary of our culture, and in each case she answered with a commercial for the usda but in no case did he answer my request and this is a direction of the party committee and asked him to engage in this to promote and protect the interests of agriculture up and down the river all the way to the top and bottom that doesn't cost any

money it is a direct model of the language amendment that urges this adoption and balance of my time. >> i believe it would be appropriate to determine if the gentleman from ohio chooses to pursue his point of order. >> can i ask my question? >> it's lead and we will be a little flexible here. the gentleman is recognized. >> i understand what the issue is and i feel for. the responsibility for the reservoir and the river systems and the flow for the navigation and flood control this issue has been under the transportation subcommittee under the environment which i chair we

have had a hearing on it and the king is directing the secretary of the agriculture, and i don't know what his perfume is. i want to make it clear the army corps has the responsibility in the jurisdiction to regulate the river. >> the chair would yield to the gentleman from iowa to come from the draft that is presented while it has a series of fact findings, they do not entail action. the action in his language is exclusively. >> that is correct and specify is by working within his jurisdiction that meeting in the secretary of the agriculture working within its jurisdiction. >> so we have the secretary

directed to do things within his own existing authority it would appear a point of order would not be relevant and i would suggest the gentleman vacate the point of order. >> the gentleman vacates the point of order with a second-degree amendment coming the chair now recognizes -- the chair recognizes the gentleman for an amendment to the king amendment. >> number 104 revised. >> this is traceable and straightforward and i think mr. king has supported on the part of the agriculture businesses in the neighboring communities the sector if agriculture shouldn't use any authority and of relationships the secretary has with other federal agencies to ensure the local agricultural economy protected from flooding.

let me explain. this little town in southwest of iowa used to be just a stone's throw out of my district when i used to fly over and as a one. the greatest ready when the country we used to go there a lot, so i know this town. the flood came and was something i was concerned about. so we checked it out pretty closely and when the levee broke on the river, the town, we've taken out and shares a list of the agricultural businesses that are very pro agriculture. this little town providing support to the thousands and thousands upon acres of cargo bumpers. this is the number-one job there in north america. and so on it goes. a contemporary levy was put up,

and until this is resolved as mr. king pointed out so well that they wouldn't be required to take that down. it just makes common sense because we don't know what is coming next with any preparations made to get so we hope this debate could the secretary will use his influence with his fellow members of the cabinet to try to influence for the benefit of this community and these businesses. and i yield back. >> the gentleman yields back his time. the gentleman from iowa. >> i strike the last word to be recognized. stacks before mr. trend. i enthusiastically endorse the second-degree amendment by the gentleman from iowa and urge its adoption by unanimous consent. >> is their objection to mr. king's amendment being amended by the amendment? >> seeing no objection, so

ordered. the amendment is adopted. now, is there any of your request for the recognition on the king amendment before us? >> i have communities that are on the river systems that have flooded every now and then as well and i just want to make sure the we are not given preferential treatment to the communities there are specifically named versus those others throughout the country that are not being specifically named. ..

speaks to directing secretary of agricultural to use whatever is in the influence. but the underlying bill they reference hr . >> because i'm down to a few seconds left. the author of the original bill and the amendment,ly respectfully vote against the bill adjust because ifn it preference really a troament to individuals in the chonty where many have flooded in caused and problems problems in many of the commune teeties. >> i yield remain of my nine second. >> i think thank him. >> the name of the city is what

troubles gentleman. i expect the gentleman of iowa be willing to work with that before we go to the floor. this is a critical issue. >> gentleman, time expired anyone et. cetera else to seek recognition. >> i would move to strike the last word. >> recognized for two minutes for point of classification. >> thank you, mr. king included in your amendment here it talks about the secretary of agricultural looking the action basing and going the great flood experience the flood of 2011. i'm wondering how that would place him in conflict with how the corp. of engineers -- i believe the model they use in the 1881 flood. i'm wondering using a different definition of met elevation to take action how that will impact

their relationship for the corp. of engineer and put them in conflict with each other through the process they have going forward. >> if the general lady yield. >> yes. >> the answer is in the findings in the amendment as well as the bill hr2941. there's many public indication that recognizes that the used to 18 1eu78 it was the greatest runoff is 2011 is now. this year it was 48 million acre feet of runoff. i don't think there's any conflict there with the corp. of engineers. >> do you believe that the corp. of gorse will be defining the greatest flood experience as the flood of 2011 as it makes calculations going forward? >> i think they have already done that. >> okay. thank you. appreciate the classification. i yield back. >> taking recognition? seeing no further question for recognition. we proceed to vote on the king amendment as amended which is

now amendment number -- clerk what amendment number are we on? [inaudible] >> 44. we'll proceed to vote on amendment 44 modified by 104 all those in favor signify by saying aye. all those opposed say no. the iowa appear to have. it the aye appear to have it. does the general lead wish to . >> no. >> the general lady is a saint. the assessment is adopted. are there additional amendments to title 12? come back to the other side.

okay. the gentleman from texas is recognized. >> thank you, mr. chairman. amendment number 34 at the desk. the clerk will distribute amendment number 34. the gentleman from stx recognized for mr. conway recognized for two minutes to explain his amendment number 34. >> thank you, mr. chairman. my good friend and i present this amendment. this amendment simply put an end to the rulemaking plaguing cattle producers for more than two years. aware of the fact that the -- rulemaking went well beyond the language of 2008 farm bill and threaten l the livestock and poultry market. in particular threat to end the value added marketing opportunity producers use to satisfy their customers remain profitable. i want to thank him for cooperating with the amendment with me it impacts producers across the country.

to kill the issue once and for all and allow them to get back to fighting back. >> who seeks recognition on the topic? >> mr. chairman. the ranking member seeks recognition. >> i move to strike the last word. >> recognized two for minutes. >> what this does is repeals what we did in 2008, the farm bill, he said it was another situation write locked him in the room, and dhaim to an agreement. it also repeals a role of the secretary is finalized since 2008, and prohibits the secretary of finalizing remaining rules. you are opening up one huge can of worms with this. and i don't think it's smart. but, you know, it is what it is. so, you know, the secretary

first performed the rule ander thought went further than what the agreement was. i work to reign those in, if you will. i feel a little bit put upon here because i work very hard to take the industry's concerns to the secretary and i think i had a lot of effect on what happened. and now automatic of a sudden we're going repeal everything, you know, maybe that's the whole deal this this congress got repeal everything that ever happened. so i don't know. but i just think it's a little much, and senate it not going touch this anyway. so whatever happens. i yield back. >> mr. chairman. >> gentleman yields back. the gentleman from iowa seeks recognition. >> strike the last word. >> recognized two minutes. >> as you know, i con cure with mr. peterson. i chaired the livestock committee.

we put a lot of effort in developing this. we should allow it. we should slow down a few pacts 30 years ago there were 1.3 beef cattle operations today there is less than 740,000. in 1980 there are 6006,000. the top four packers have control over 81% of the sales cattle slaughtered in the u.s. we have to allow this to continue to be developmented and watch it closely if you want to do that. i concur with the watch of it. i'll work can chairman willingfully and hope we can keep an eye on it. i don't think this is right thing to do at this time. and i would . >> gentleman yield. >> yes, of course.

>> and i -- i wasn't intending to insult ranking member. but we're still getting complaints the rule the went too far. and, you know, it's beyond what the court said. the department of agricultural basically thumbed their noise at us time and again. i appreciate both of your comments, but my producers are telling me it's not working. the folks went out of business because they weren't as sufficient as they need to be. not because of the circumstance and not allowing the value-added market opportunities. >> i yield back my time. >> why don't we temper it down and sit down and figure out sow way to draw back somewhat and do what is appropriate here. we need to protect these producers. >> i yield back. >> gentleman's time expired. >> mr. chairman. >> i believe the gentleman from georgia seeks recognition and come back to the gentleman from california. >> i move to strike. >> recognized two minutes. >> and i know mr. boss well told

me a lot of farms going out of business. the federal estate tax is a reason a lot ever farms go out of business. we need to get rid of that for america's farmers. i yield my time. >> you understand the concept late at night. the gentleman from california seeks recognition. >> thank you i move to strike the. >> recognized two minutes. >> i think we're all sensitive to the changes occurred and the various livestock altering pork industries over the recent decades. and i think my friend and the gentleman from minnesota is correct, he worked very closely with a lot of us in the 2008 farm bill to try to find some sort of happy medium. i think this amendment, which i am cosponsor of, is really a reaction to what we thought was an overreach on the part of the

u.s.d.a. over the last 18 months after the 2008 farm bill had passed. in attempting to take the regulatory process and to pursue an area that the congress had rejected in terms of consideration in the 2008 farm bill. and while i hope this could be worked at some other fashion, nonetheless, the fact is that with the changes that occurred over the industry over the years, there has been no proof that in my view, collusion is takes place within the changes of the industry and the regulations weren't overreached. whether or not there's some other alternative by this legislation that can be worked out of the conference committee, i would be open to it. but those of us who are very critical with the department

last year, and a finally pulled back i think in part to all of our responses, and to congressman peterson's as well. this is reaction to what we felt the administrative branch, the executive branch, superseeding it's role on law that had been pass and enacted. i support the amendment, and maybe this is something we can don't work on. >> gentleman's time expired. i believe the gentleman from texas seeks recognize. >> i strike to the last word. >> yessing niced two minutes. >> i'll be brief. i want to associate myself with mr. conway remarks, but, you know, i think piece of legislation was initially chasing a ghost that didn't exist and the rules have been overreaching and one of the thicks that gentleman said that there have been a lot of consolidation in agricultural. yes, there has been a lot of consolidation in agricultural. the way that many producers have been able to stay in business is

they had to scale their operations and scaling the operation they need capital to be able to do that. in order to get the cap that tal from the bank and other places they had to be able in many cases, hedge the opportunity so our forward contract to be able to get the fntszing to do that. many people have been able to take marketing opportunities with certain kinds of breeding programs and so forth. to enhance the prop ability to stay in business, and so i think this amendment makes a lot of sense i would encourage members to support this amendment. with that, i yield back. >> gentleman yields back. seeing know other request for recognition. we'll proceed to vote on amendment number 34 all those in favor of amendment 34 will signify by saying aye. >> all those opposed to amendment number 34 will oppose by saying no. it appears the ayes have it.

appears the ayes have. they have it. amendment number 34 is depositedded. are there additional amendments to title 1? turn to the lady from missouri. she seeks recognition. >> yes, thank you. i have amendment number 10 at the desk. >> teament number will be 10 will be distributed. the clerk -- and the lady's recognize for two minutes to begin the explanation. >> yes, thank you mr. chairman. the amendment is nothing hopefully we can support it provides information to returning veterans about and connecting returning veterans with beginning farmer training and agricultural vocational rehainltation program appropriate for the needs and interest of returning veterans including assisting veterans in using federal veteran education

benefits for purposes related to beginning and farms or ranching career. specifically it will help the usda to work with the institution of higher education and nonprofit to conduct research and training programs focus on veteran farmers. small farm production and agricultural job offer viable avenue for veterans to recorporate into society. over 1.5 military service men and women have served in operation freedom and will return to the country as the operations end. nearly 665,000 of the un. sustainable job opportunity for our veterans through practical hands on approach incorporating research, production, and economic innovation. with that, mr. speaker -- mr.

chairman i ask for everyone's support and yield back the time. >> she yields back her time. would any of my colleagues sec recognition to discuss number 10. >> gentleman from california. recognized two minutes. >> the first section of the assessment identical to boss well and gibson amendment. we're dub candidating something that was done before. and the second portion of the amendment duplicates what the beginning of the farmers and ranchers development program already does. it seems like we're doing the same thing we've done before. and it seems like we want to be cost effective and don't have other programs in place that we've approved. and then, the dp program already has a 50 million mandatory funding available in the bill for competitive grants to institution and nonprofit entities we don't need to create

down cat programs response i don't believe this intil needed since it's already been done. we're wasting a lot of our time. >> gentleman yields back. anyone else seeking recognition on the point? >> the chair will move to strike the last word and recognize himself. the amendment clearly authorizes new grants and contracts. directing the secretary acting through ars to enter onto higher education and nonprofit organization for five purposes. the notion i suppose this amendment will not cost any additional dollars i have to believe is incorrect. in light of that, when the new authorization added to the program that either spreads a smaller funds thinner. for these reasons i must oppose the amendment and yield back anyone else seeking recognition?

all those in favor signify by saying aye. all those opposed signify by say nothing. it appears the no have it. they have it and the amendment number 10 is not adopted. are there additional amendments to title 12? >> turn my friend and neighbor from kansas. >> point of order. >> point offer of order. >> the gentleman reserves -- gentleman reserves a point of order sponsor of the amendment is recognize for explanation. >> thank you mr. chairman. thank you -- number of the amendment, by the way? >> well, i have two amendments actually. no need to distribute them. i will be asking consent to withdraw them. i want to bring attention to the democratic national committee and hope -- hope to offer those tonight. they deal with two issues that number one we dealt with in the house dealing with the farm dust

issue. and hopefully i'll have an opportunity to offer that on the floor. and in the second one deals with the growing issue from the epa dealing with waters, and many of us are aware the epa issued guidance document to expand the authority to waters and strike the navigable. ly not offer those here's. i understand the jurisdictional concern, i will note my farmers and ranchers in kansas could careless about jurisdictional concerns up here. they're worried about the epa and what they're attempting to do. i ask con sent to withdraw the amendments, mr. chairman. >> gentleman withdrawals his amendments. or amendment singular? and yield back the balance of his time. are there any other amendments to title 12?

any other amendments to title 12? there no additional amendments title 12 is close. that was the final title in the farm bill markup. yes indeed. i now turn to the ranking member for recognition. >> chairman, i move the bill hr0683 amended be reported to the house with the recommendation that it do pass. >> the question is on the motion to favorably report as amended all in favor signify by saying aye. >> mr. chairman, i -- sky for a roll call. >> gentleman asked for a roll call.

he's well within the rights. the clerk will call the role on h6083. [roll call vote] [roll call vote]

[roll call vote] [roll call vote]

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[roll call vote] mr. chairman the the vote is 35 ayes, 9nays. [applause] >> call the vote. you are correct, we had two members who passed. please record them, clerk. the final tally. >> [roll call vote]

>> clerk will correct the tally. final tally is 35 ayes, 11 nays. >> the bill have and the bill amendmented is recorded and report favorably to the house after the ayes have it. mr. chairman, i ask unanimous consent the chairman members -- chairman have after consideration consulting with the ranking member the authorize to make adjustments to spending levels in the report. version of the bill are necessary. >> without objection so ordered. does any member give notice to file abuse to the bill considered today. it will be so noted in the record. without objection the usual instruction are given to staff making such confirming changes are appropriate without changing the substance the legislation.

the meeting is now adjourned [inaudible conversations] [inaudible conversations]

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agricultural and food policy issues for "congressional quarterly" taking look another the farm bill debate what are some of the key policy issues that have been debated so far? >> well, this bill makes a major changes in how farmers are supported. how the commodity programs. they are going to do away with the system of fixed annual payments that farmers have been getting since ?aix. 1996. they have become politically unpopular and difficult defend. both the house and the senate are moving to do away with those direct payments. it move soms of the savings money that is left over into

crop insurance and into programs that are more like crop insurance than the traditional support programs. these will be some kind of payments that will be more directly tied to fluxuation and prices and crop yields. ..

this at this bill would debt spending by about $35 billion over 10 years. that works out to about a 9% cut in commodity and profit insurance programs and what we think of as farm programs. there is about a 9% reduction in land conservation programs. these are programs that subsidize the cost of pollution control on farms that take environmentally sensitive land out of production. >> what about some of the key differences between the house and senate version of the farm bill?

>> okay. there are some differences that are significant to farmers in terms of how they are going to reform the current system of crop subsidies. and they are mostly significant to region by region. this senate bill is more favorable to crops that are grown in the midwest like corn and soybeans. the house bill is going to be shifting a little more to support towards southern crops like rice and peanuts and cotton so it's very much a regional difference between the house and the senate. >> are there also differences between their visions for the food stamp program? the levels of spending for food stamps? >> right, both bills would cut

food stamps by the overall cut in the house bill about 2% in the projected spending. it's about 11 or $12 billion more than the senate. the senate would also make a cut of about $4 billion, which is well under 2%. these are reductions that are actually restricting the eligibility and in some cases, in the case of the senate bill, it is targeted basically at 15 states that are currently provide heating assistance to families in order to give them an increase in benefits. >> lastly tell us about the timetable for getting this done on capitol hill before the september 30 deadline. >> well that is a big question. the senate has passed its bill.

the house agriculture committee just today is marking up or moving on amendments to its bill. it will be finished presumably by tonight. the big question comes as to what we do with the bills from then on. there is some thought been given to bypassing debate on the house floor and just sending this bill to a conference committee to negotiate a final version directly with the senate. the normal process would be to take it to the house floor and debated there, kind of open for amendments. and then pass before it goes on to negotiations with the senate, but for a couple of reasons, the managers of the bill are considering bypassing it. they wouldn't have to worry about the amendments that might be targeting the bill on the house floor and second of all it was certainly speed up the process to go directly into the

conference in the senate. there's not much time, september 30. >> fellow brasher covers food and agriculture issues for "congressional quarterly," keeping an eye on the farm bill debate. thank you for that update. now five doctors testify before the senate finance committee urging lawmakers to replace the sustainable growth rate formula that calculates a continued reduction in medicare physician payments. they say replacing the fdr will not be easy and will take time. this is the committee's third

round purposing on medicare payments. this is an hour and 45 minutes. and. [inaudible conversations] [inaudible conversations] [inaudible conversations] >> the committee will come to order. albert einstein once said, a great thought begins by seeing something differently, for the shift of the mines i. today we hold their third

roundtable on medicare physician payments. we have heard from former cms administrators and private payers. we are here now to see things to the eyes of those who receive the payments and provide the care. every year the sustainable growth rate or sgr leads physicians to fear dramatic reductions in their medicare payments. next year physicians will face a 27% cut if we don't act. while congress has intervened to prevent these cuts each year, it is time we developed a permanent solution. we need need to repeal sgr and in the annual -- year in and year out uncertainty on positions or the medicare beneficiaries who need access to doctors. thinking about new ways to pay physicians, we must clearly focus on controlling health care

spending. physicians can help us find solutions. they are after all on the frontlines of health care delivery. 97% of medicare beneficiaries see a physician at least once a year. and beneficiaries with chronic conditions see their physicians at least monthly. by ordering tests and writing prescriptions and admitting patients to hospitals, physicians are involved in up to 80% of total health care spending. indeed physicians suggest changes to medicare physician payment systems, spur high-quality, high value care. today's panelists, to look for solutions short-term and long-term and like einstein said they can help us come up with a great thought by seeing something differently. we need solutions that will work for both primary care and

specialist. and they need to work for beneficiaries with chronic conditions. after all, these beneficiaries account for two-thirds of total medicare spending. we look forward to candid and direct -- senator hatch will begin a moment. he is currently on the floor. meantime i would like to introduce the panel is. panels. beginning with to my left, doc there ammons karl kissner president-elect of the american medical association. next his doctor glenn kandi won president of the american academy for family physicians. third will be frank opelka vice chancellor of surgery at university health and sciences center. fourthforth, dr. douglas weaver.

dr. weaver is vice president and rector of heart and vascular services at the henry ford health system. and finally, dr. barbara mcaneny, chief executive officer of the mexico oncology hematology. as a reminder cure what written statement will be in the record. please submit your statements in three minutes since we have your senators here today. please limit your comments to three minutes each. i would like to be more of the nature of a roundtable. after each making statements of one or two questions and i would like you to interchange back and forth. if you want to say something, pipe up and say it. so you start. we are happy to have you here. >> tenured not chairman baucus for convening this important

roundtable discussion. i am president-elect of the american medical association and internal medicine and infectious disease specialist in lexington kentucky. we'll know the sgr is failed and it must be repealed and replaced with alternative payment and delivery models to support high-quality and high value care. as we move forward two factors are critical, physician practices widely vary in the development and dissemination of innovative practice and delivery models are proceeding at different paces. a large multispecialty practice is currently better positioned to implement broadscale innovations that is a small rural practice. flexibility in a menu of multiple solutions are needed on a rolling basis. and secondly alternative models must cut across medicare silos. when physician care achieves overall medicare program savings the physicians and medicare

should share in those savings. currently additional physician services that prevent costly medical care drives deeper cuts under the sgr. this incentive structure has to change. physicians have already begun transitioning into alternative payment and delivery models. this includes for example 154 of medicare accountable care organizations and the center for medicare and medicaid is testing many new models. many innovations are also being conducted in the private sector as the committee heard at its june roundtable. ama strongly supports these initiatives and is helping physicians with the transition. for example our ama convened physician consortium for performance improvement as developed measures relating to outcomes and overuse of care and is expanding its work in this area. congress can take immediate steps to help in the transition. first congress should require

cms innovation center do offer opportunities for physicians to enroll in new models on a rolling basis. cactuses can then plan for needed changes and join as they become ready. this will increase physician participation in new models and significantly aid the transition for small, so low-end rural practices. second, congress should require cms to modernize its medicare data system. due to cms's antiquated system providing physicians with actionable, real-time data to guide decision-making has been difficult. physician access to such timely and relevant data is the key element behind the success of the private sector model success in the previous june roundtable. third, congress should provide medicare funding to cms for quality measured development, testing and maintenance and four measured review and endorsements. this is critical to ensure that meaningful and up-to-date

measures are available for federal quality programs. the ama is eager to continue our work with the committee to transition to a new stable system that strengthens medicare. thank you. >> thank you dr. hoven. dr. stream. >> chairman baucus and senators for inviting the american family physicians state our views rvs bleeped out canion is an efficient and delivers lower-quality care barzee because it undervalues primary care. bft is convinced that no single alternative payment method will rebuild primary care. we needed combination of methods. of a mp promotes the patient-centered pcmh supported by a blended blended payment system that includes fee-for-service care management fees and the quality and payment. we know it works to improve health health care and restrain costs in the long run. the evidence for this is accumulating rapidly in our statement provides several

examples. findings from the programs across the nation are compelling success in improving quality and restraining health care costs. earlier this year afp sent recommendations to the acting administrator of cms. these were the result of a sponsor task for some primary care valuation. the key recommendation is in order to build a system of care that will piece consistently more efficient and produce better health we need to pay primary care differently and better. recall to your attention and medicare the medicare physician payment innovation act, h.r. h.r. 5707 introduce by joe head. it makes a notable step towards recognizing the critical need to pay primary care differently. the cms innovation center is several program testing centers that support primary care. for example the primary care, comprehensive primary care initiative includes several health plans of various markets that will offer a per patient per month care coordination fee for primary care physicians

whose practices are effectively patient-centered. the primary care extension service program is managed -- administered by the this deserved attention. without funding this program is designed to disseminate up-to-date information about evidence-based therapies and techniques to small practices. aafp strongly recommends congress on the primary care extension service program. we ask for your continued support of the primary care incentive payment pc ip to 10% medicare bonus payment to primary care physicians and providers for certain primary care services. the commonwealth fund recently published a study that if made permanent would deal with a six feel -- sixfold return. the net result according to the study would be a drop in medicare costs cost of nearly 2%. senators we all want the same thing, better health care at less cost. there is a proven way to go a long way toward achieving that outcome, invest in primary care.

we have ample evidence that doing so will not increase the overall cost of care per individual per year. thank you recommitment to the help of this nation and family physicians are eager to assist you in making the differences we need. >> thank you serve. dr. opelka. >> thank you for this opportunity. high comes you to speak on behalf of improving to care for the surgical patient and inspiring quality among surgeons. on behalf of the american college of surgeons there a couple of key points i would like to make and share with you. we have several programs and initiatives that we are working on to inspire quality and improve the quality of care and we believe that actually helps reduce the cost of health care today. by reducing things like surgical site infections, read missions and complications that patients suffer. there are two key programs i would like to bring to your attention when in the short term and one in the long-term. a short-term approach is to look at the various clinical

registries that we have developed over the years and those go back 10 or 15 years, where we have accumulated millions of data points on patients that drive quality improvement. these registries are the cancer registry where we have over 11 million lines that we track the outcomes of improvement in cancer care, the trauma registry and perhaps focus more explicitly today on the national surgery quality improvement register you. that is a registry that began in the va some 15 years ago and today is an over 500 hospitals. it is driving quality improvement, reducing patient applications and reducing costs related to those complications. we have worked with with the msn it's time to improve that work was a must to bring those registries to the next level of the value proposition seamus is working on so we can strengthen surgical care and improve the quality of care across the country. we like to expand from a the 500 hospitals every hospital.

the long-term view in the long-term point i would like to make is how do we actually replaced the sgr quakes we have been working on a proposal that ties together all these value initiatives that we have been working with cms on, all the value programs into a value-based update using targets of improvement, targets of improvement in cancer care and trauma care and targets of improvement in cardiology, targets of improvement in chronic intervention care. focusing those as the targets for updates, bringing physicians and hospitals in alignment on the set of targets that actually replaces the sgr was something we value, improve the quality of care and reducing the costs related to bad care and to overuse of care, too unsafe care and poor quality care. we think there is an opportunity to further explore this as a value-based update to replace the sgr within the context and

framework we are currently using throughout all of our programs both public and private for a better health care system. thank you for this opportunity and i look forward to our dialogue. >> thank you doctor. dr. weaver. >> i'm dr. weaver, vice president of cardiology and assistant medical director for services in the ford health system in detroit. i'm please to speak you on behalf of the american college of cardiology. if the college to make one suggestion for medicare payment policy would be, create stability in the system. it is badly needed right now. the current uncertainty around medicare physician payments, around the aca and its initiative is seriously competing -- impeding progress by physicians and hospitals towards delivery and payment reforms. the colleges had several decades

of experience developing and applying quality improvement tools including producing clinical practice guidelines for diagnoses and treatment of common cardiac diseases, producing appropriate use criteria which allow physicians to better apply the right tests, diagnostic testing and cardiac procedures and then our clinical registries in which physicians and hospitals can submit their data around cardiac procedures. they can then get back and are able to benchmark it against whole nations as well as -- we believe the broader use of these tools will improve quality, produce better patient outcomes and will lower costs. let me tell you you of some the lessons we have learned in these years. number one, data is the key. efforts to improve quality and efficiency must be grounded in the use of the best scientific evidence available. the collection of robust clinical data, measurement and

feedback on performance. doctors are data-driven. they have competed throughout their entire training to be the best and they respond to credible data. particularly, that is produced by their special society and of identified particular problems that need to be improved. number two, flexibility and. new payment must be paired. one size does not fit all. we applaud the beginning efforts to report care ordination but cms needs to seek out additional local solutions and increase value and reduce costs. third come incentive throughout the entire delivery system to include the payer, the primary care physician specialists, the hospital and the skilled nursing facility. currently we are too often competing with each other instead of being aligned.

payers are trying to reduce costs and hospitals are trying to build beds and the physician is uniquely positioned to ensure patients get the highest quality care at the lowest cost, if, if the current system is revised to this approach. rewarding physicians for providing the right care and using an appropriate amount of resources is essential to solving the medicare spending crisis. the college urges congress to incentivize the greater expansion and use of quality improvement tools such as ours. i look forward to our dialogue. >> thank you, sir. dr. mcaneny. >> thank you chairman baucus, ranking member hatchet members of the committee. thank you for the opportunity to participate in this roundtable discussion. my name is barbara mcaneny and i'm a medical oncologist practicing in new mexico. i am here on behalf of the american society of political

oncology which represents 30,000 oncologist. we support your pursuit transform the medicare payment system to encourage high-quality, high-value care for individuals with cancer. we hope that congress will replace the sgr and soon. the sgr has created great instability in our practices and is a -- eroding effective networks of care. a fair and responsible system that rewards evidence-based care and recognizes that many positive services, including end-of-life counseling are critical to treating patients with cancer. any new payment must enhance access to care and do no harm. quality for cancer patients providing accurate diagnoses, appropriate evidence-based therapy delivered safely and the strong support system for the human needs of the patients in and their families.

asko has developed a quality program in which thousands of oncologist already participate voluntarily. the call at the quality oncology practice initiative or kobbe. i've participated in this program i know from experience that beneficial effect it has had on supporting quality in my own practice. it is frustrating however that i also have to report through medicare's last -- less practice enhancing program. we believe that leveraging kobbe would be in a median first that congress could take to promote quality and efficiency while reducing the administrative burden on oncologist. secondly we urge you to rely on the expertise of oncologist as you move towards transformation of cancer care that temin and delivery. policies that have the effective community cancer care can exaggerate existing disparities for rural patients. cancer care is generally delivered in in the patient's

home community and cancer doctors have developed a sophisticated infrastructure that allows them to administer dangerous and toxic therapies while allowing patients to remain at home with the people they love. therefore we would like to emphasize that new oncology models must be tested in pilot programs that reflect the diverse population that we serve before they are generally implemented. any change in the payment system has the potential for unintended consequences for a very vulnerable population. harper oncologist our already involved in many pilot projects testing payment mechanisms which could help control costs. i'm the recent recipient of a grant from the medicare and the patient-centered to test model based on medical home concepts by limitation. my project involves seven private practices of oncology from maine to mexico. we can save money for the system of providing better health in

better health care. i'm happy to talk about that further if you would like. we stand ready to assist you as you move forward. i'm happy to answer any questions. >> thank you. just one question. since physicians are so involved with such a large percentage of payments, health care payments, and our country, seems to it seems to me that maybe there is a little bit -- the sgr for physicians only and if physicians are so involved in the health care payments that are made elsewhere in the system. perhaps if we look at sgr, there might be some way where physicians are involved and reimbursed in a way that helps involve them in choosing the

care given to patients more holistically. currently people say where'd to still fight. and one stovepipe two of a degree is sgr. but any thoughts you might have on how we can collapse some of these pipes and especially the role of decisions because physicians are so heavily involved, the figure i have 80% health care dollars related to physicians. your thoughts on that. anyone of you who want to pipe up. >> i will start. thank you that question because i think it's something we all chat about on a regular basis and i think if we start looking for value within the system it will be the physicians and those practices that are looking at the models of care that are being used, be they in primary

care models, medical home modely are. we are going to be looking constantly at the value of each of those delivery reform issues going forward. we have to be accountable as physicians for making sure we are getting the job done and the outcomes and quality of the work that is being done and new models that will be tested better on the road right now. up to now we have not had that information. it's very important going forward that we look at a friday bottles and we recognize the importance of whether it be a small practice, large integrated group or what have you. it's very important that we look at all of those and take it into consideration. >> what the policies are you talking about? >> we are talking about the primary care medical home model. that is the one of the models with talked about. bundled payments again another

bottle and frank can probably speak to that so those are out there in place right now as we are talking us. which of these models might bear fruit? >> i would speak to the cdci currently recruiting practices through the innovation center. the care coordination that has to do with coordinating care but the answer to your question senator, the shared savings component of that model breaks down the silos and there's the potential for shared savings from reducing hospitalizations and reducing er visits, reducing complications of cardiac illness that results an expense like dial out -- dialysis.

if you they sit on the physician services, there are -- there is too little skin in the game for the position but if the shared savings model looks across the silos, then there is a win-win for the physicians making the effort that the medical home -- goes. >> you think there is potential? >> absolutely, it's a game-changer. >> mr. chairman isn't that what they put in the health corp. l.? >> parley. that that is a systemwide integrated delivery system, the multispecialty clinic in that kind of model. i'm talking about the level of supporting the primary care necessary for high functioning systems where there's an aco or separate. >> mr. chairman? atingua both the doctors are talking about, the independence at home model that we got the affordable care act. the oncologists are making the point that most of the medicare will today goes for the

chronically ill. that is where most of the medicare bill goes and there approaches like independence at home and we have seen these demonstration sites begin. it is in the ama testimony. we can take a much bigger population, number one, leave the patient in a position to be happier as the oncologist noted and start using the payment systems just reward those kinds of efforts. i really appreciate what the ama is said that and why don't we hear from the college's. >> thank you, senators. i do have the opportunity to improve a model with with this innovation center grant which allows physicians to control those things we really can take control over. there are a lot of parts of health care and the cost of drugs that we have no ability to manage, but we can manage the site of service and we all know it's a lot less expensive to treat people in our offices then

it is in emergency departments in hospitals. in this grant that we wrote we use data and i agree that data is key for my own practice showing how much money we could save medicare. in one small practice in new mexico, by keeping people in the office, aggressively managing the disease and the side effects of treatment so that we keep people out of the hospital and we keep them healthier and we keep them out of emergency departments. those are the things that doctors can control. so with six other practices across the country we are going to demonstrate at if we create ourselves as an oncology medical home, that we are ready to accept a bundled payment. give us a payment that will allow us to take care of these patients. it will cost more in the outpatient arena that the savings are far made up or an inpatient setting when we keep

people here. we think we can generate your savings in that manner and better care. >> mr. chairman? i wonder, dr. weaver could you talk a little bit about -- i know it's part of the eighth multi-payer primary care -- >> i wanted to give a couple of examples where we might have savings and that is one of the things that cms is starting to which i must applaud is paying for some care management. that means supporting the infrastructure which may be nurses, medical assistants, part-time pharmacist, really not doctor staff. this is stuff that keeps people on the right, on the right care plan as well as keeps them out of the hospital. in michigan, the blues along with cms and all of the payers have rewarded positions in primary care an extra $79 per member per month to do care

management. they must meet certain quality standards. they must meet certain utilization standards to qualified. the state itself this year because of this project, thinks the dual eligible expenses will drop $38 million. so that upfront investment should get more management help. i will give another example. the blues in michigan fund cardiac data registration. doctors -- though the only thing that data suggests, say is you must submit your data and you must meet quarterly to discuss among all of the hospitals. it has led to huge reductions in complications and improvements. they did the same thing for pediatric surgery and they got together. there was a database, they got the data back and complications from surgery have dropped 30% and readmission or patients who

had acted surgery has dropped 35%. so i point out that care management, as well as, i will tell you again, doctors are data-driven. if you give them the infrastructure so they have conical data that updated that they believe is credible they will respond in ways to improve the quality of their patients. they all want to provide the best possible quality of care. >> just as a follow up doctor or for anyone we have this policy set up under him medicare and family have one third of physicians who are actually using that and in 2015 it goes from an incentive to a penalty. what are the barriers and where more physicians doing it since we are talking about it david -- data-driven system? >> let me respond to that and cms is currently promoting a lot more transparency with their data. but the measures that are

reported, readmission rates, smoking cessation in these things, there very very crude measures and they don't tell you what what do you have a good doctor, a great doctor or someone -- as others have suggested they want to report the things that they think are important and have developed within their own specialty to say these are the problems, here's here is how we measure them. give us the data back so we can benchmark and they will improve. >> if i might respond to that as well because oncology for years before this came up developed quality oncology practice initiative which was a bunch of oncologists saying what can we improve what we do? this costs money for practices to participate in but thousands of oncologists have participated willingly spending that money to do a better job. because we can craft measures that really are pertinent to

what we do every day and am a complete one measure, we just say everybody is caught that. let's move onto the next thing. lets do the next step in each of the specialties can do that, to create their own quality system instead of having a broad rush generic measure. >> as well as being more flexible. i'm sure all all of you have heard about the times treatment for people with a heart attack. the oncology put -- department of together program many years ago and people moved from 50% to essentially everywhere. you want to move on after that. you have got that one down and you can't regulate that. you have got to allow the specialties to see where the boys right now and send physicians to participate and make sure the infrastructure in order to collect this credible clinical data and you will have a much more reactive and fast

turnaround and improved quality. >> one of the things we have tried to put in that affordable care act was a focus on reporting about outcomes. it seems to me that you know, a sort of underlying or over arching dataset that should sort of spam all of the various specialties would be, how do we get back to reporting on outcomes for patients? is that realistic klaxon mean is there a way for someone to, for cms or government or anybody else to say okay here is what we want reported on that relates to how well people are doing after they get this treatment. >> if i could, thank you very much for that question. the oncology surgery programs

are readjusted to outcomes reporting and it's very effective. for example in the field of general and vascular surgery and over 500 hospitals we correct -- collects 100 to 130 data elements over 30 days on the patient's care. that data then churns out into the risk-adjusted expected outcome and we measure the actual outcome against the expected. it's very meaningful to the delivery system and these are key based care systems. it's not just the surgeon. it's the nurses, pharmacy records primary care and linking to my colleague here. i don't have good surgical outcomes unless i have a good patient to work with. i can measure and see one of the tried -- what are the drivers for better care? we have been working with cms who really i applaud their efforts and performance measurement. we have to start somewhere and we started with measures that were less than perfect but it has moved assault and data is a

drug. we are addicted to it. we can't get enough data and we want to meaningful actionable data. so we have partnered with cms and started to show them how the current data sets they have don't get them the answer they want and we are showing the more meaningful data sets. and where we need help is how do we actually expand this infrastructure beyond 500 hospitals, 4000 hospitals, how can we link this beyond surgery into surgery and primary care across the patient continuum so it isn't about how well by took someone's colon cancer out but it's more about how well 18 months of critical cancer care grew the best outcome for that quality. we are closer today than we ever were that there are a lot of things we need to do, some infrastructure components we need to build upon and build the business model into it so everyone is aligned and we all have shared incentives. we are very excited about going

forward and we actually are looking forward to taking that next step. >> just like i don't think there's a single payment solution across all specialties because there are unique differences in the question of quality, the issue for primary care is often treatment of chronic illness and it is payback time to have good outcomes might be five, 10 or 15 years. to avoid them being on dialysis 10 years from now so instead these quality measures use our short-term -- what is your blood sugar control and having have you had your fee check? if we use these measures that aren't truly outcome measures because the timeline is too long and then you get into a debate about are the proxy measures the right measures? that is what dr. hoven's point was, we want to make sure those are valid measures that reflect value and the things that we

should be measuring and working to improve to get those eventual outcomes. [inaudible] >> i don't know if your microphone is on. >> is that better? >> delights help. >> you were talking about quality and outcomes in one of the things in the affordable care act is moving to this value-based modifier system so when you look at the estimates on medicare, $120 billion per year due to unnecessary tests and procedures. so i mean how have we proven

that we can deliver better care at lower cost and how to implement that system, so that people as you were saying, are incentivize to do the right thing is supposed to -- >> i can jump in on this. this is a good first that. i think clearly, the concepts are in there. what we have got to now do is look at the map of the -- methodology to make sure the methodology gets us to a good place. i do think it is a good first step. we are in the process of reviewing it so i think we will be getting back to one that's what i believe it's a good first step. >> let me in make a couple of comments senator can't well about this and that is about the value-based. i personally am very worried about the way to structure. prevention measures as well as look at the cost that is

regional. i have to tell you that what people have said today is you need meaningful, credible data in order to do any adjustment for what the outcome or what the cost should be. i lived in seattle. when i moved to detroit, i had never seen a population like this before. they would never get adjusted for adequately with administrative data. you've got a population which 25% of the people graduate from high school. they are working just to stay alive. you have people that have burned up their kidneys with long-standing hypertension when they are age 30 and 35 years old. i never saw then seattle. they are very different people, very different kinds of people and so taking crude measures to try to adjust the severity and adjust payments would be a huge mistake in my mind.

and so, the value that you will of some of these a sheltie's is that people literally spend many many hours trying to figure out what is going to be legitimate here when you do risk adjustment and what is not. they are the experts and they understand the disease. and you have to be very careful. the other thing that the cardiologists have been using is appropriate use criteria. what these are our the panel gets together including a panel of payers and physicians and other experts, and they looked at a lot of conditions for which we really don't have solid guidelines for. it's just science and they say this seems to be reasonable, knowing what we know. this is not so reasonable. a year ago, we started providing feedback to the hospitals on the use of stenting, and there were a proportion of cases in which

they were considered to be unnecessary. we never expected that number to be zero because there are individual differences and so on but you ought to be pretty close to what the national benchmarks are for these numbers. so we have seen come since we have started producing this, a decline in that number and in fact if you look there has been a decline in stenting procedures in the last year or two years in the u.s. and it is predicted to go for there. so providing credible data, giving it back to those doctors will change the way in which they behave. >> i certainly believe in credible data and i don't know dr. stream if you want to weigh in on this. i mean, when i think of spokane, think it's a great place and i certainly think that the population was near perfect is a

good symbolism but i don't know if we are talking about health care populations are health care practices and i certainly think we have healthier practices in the northwest, rewarding things that have driven down costs and produce better outcomes. and frankly, people in our region are very frustrated that we deliver care that way and get less reimbursement and less people want to go practice there and somebody can go practice somewhere else where they can burn up the bill of the american taxpayer. my constituents will be happy to give give a date approaches to assume they are healthier and someplace else is sicker and we should just pay more is not going to work. so i'm glad we are moving on this track and i guess we are going to have to focus on what the data is. if you have any comments on that dr. stream and also on what we need to do to encourage graduate medical education, looking at the numbers they're looking at,

to get medical homes in primary care. we have a big gap right now encouraging primary care physicians and what do we need to do for graduate all education to really get that workforce plugged in? >> several questions in there. certainly we need good data on all of these things but populations do differ somewhat. inner-city populations have more poverty and less education. >> the seven huge impact on the health of our public so we need good data so we are making risk adjustments. i can speak to value-based purchasing as not necessarily approach ramp a probe ran but a concept that applies to primary care and we absolutely have to build a stronger primary care foundation if we are going to heaven exists s. and improving the quality and cost-effectiveness of our health care system. health care system. that really is this land of payment model supports them haitian patient home model decreasing over time the importance of fee-for-service, having a meaningful care

management fee, prevention and wellness and the beast that gets your question is that shared savings these or pay for performance could include both quality measures and appropriate use, efficiency criteria but that would be the third leg of the stool. but you are also right and i appreciate it you talking about the workforce issue and i would emphasize decisions made that include an influence special the payments have a huge influence on specialty selection of our medic students and currently a strong disincentive to people who choose primary care. we have to narrow that gap between primary care physicians and subspecialty income to have the impact we want. >> for what everybody's been talking about to if the work horse not to implement the strategy we are talking about? >> absolutely not.

>> thank you. are crispy if i can follow up on that senator. the whole issue of medical school education and graduate school education, we at the ama have been looking at this very critically and this is a problem which proceeded current issues. looking at spots for medical education and a change in crichton and medical schools making sure that primary care is being taught and rendered in places not traditional for primary care education that we are expanding the venues in which we can education to all of these things are on the table as we talk about it. take 710 years to row eight doctor and we have got to get the slots bill out. we have got to have more funding towards that as well and it's one of the imperatives that is part of this whole discussion. >> mr. chairman? thank you very much. when i first started law school, one of the things that was

impressed upon me was the difference between a profession and a business. it was all about the individual client. you had to get your absolute commitment to the client with a client could pay or not, for regardless of their idiosyncrasies and i began to practice and defense work and found it was true in the medical profession. data is collected to provide information about averages, but every patient is an individual and i know that all of you are committed to treating everyone of your patience as an individual. the rub comes when you are treating patients that are paid for by the united states government under a set formula of one kind or another. and my question to you is, in devising, and we recognize that the formulas, the pay scales, however they are going to become

embedded in a replacement for sgr, will need to be developed by the professionals themselves to take into account individualized circumstances including regional circumstances in the country has senator cantwell was just pointing out. but my question is, is sufficient attention being given to the requirement that the care really be patient-centered? the patient walks in the door and i have one obligation one obligation only, to take care of that patient to the best of my professional ability. at the end of the day i've got to get paid but not to have the payment drive the care. and then a second sort of related question is, when we deal with this, because of our unique budget requirements here in the congress, we have to set

the 10 year plan out, and it's very hard for us to know whether the eighth, the ninth in the tenth year are going to work with what you are recommending for us in year one, two and three and so on and just for our own purpose i wonder if you have any suggestions for us or if you want to get the information to the chairman later, how would we devise something we think is going to work over shorter period of period of time but we really don't know. that was one of the problems with sgr to begin with. thank you. >> mr. chairman thank you and senator coons zero thank you for the question. two responses to this in my mind. where we have began with performance measurements and valuing services is still in the silos of care. at the various different performance programs and it's not as patient centric as a cookie. as we start to spread performance measurement across

bundles and aco semiwith a population-based performance, how well we are they are taking care of the continuum and research sharing the attribution, it becomes more patient centric. so where we were 30 or years ago when we started really pushing hard on performance measurement was at the beginning. how do we begin to measure individual physicians and reward them? we have grown over the last couple of years to start to understand some of the points made by my colleagues at this table and from the input from all stakeholders, from the purchaser groups, from the private payers and from patients who are helping us look at this and say well this is a better measure because it really is more meaningful to the patient. and as we move to that, doesn't necessarily fit within the payment structures were silos of payment, so we have to look at alternative payment which is to my second . and that is where we had

proposed replacing the sgr with the value-based update which says, pick the target. we want to improve cardiac care dissuade and it's not just the cardiologist. it's for primary care of the cardiologist and the cardiologist and anesthesiologist. that is the target we want to get to and let's try for that target. i think we are becoming more patient-centered. we are not quite there yet but we think replacing the sgr was something that is patient driven does a good get to eight to 10 years? i hope so, but it may take us a to 10 years to even get to that point. will it be something else 12 years from now? we are always evolving on this so i'm not going to say this is forever. >> it's a fascinating question. does anyone want to respond to

that? >> i would like to respond to the patient part. i agree completely when a physician is an examination room with a physician bear -- should be the highest part in making sure that patient gets the treatment that they need that will improve their health and improve their quality of life but what we are finding anna goes to senator cantwell pond -- acts/comment, my responsibility as someone's physician is to make sure they get the care they need but they don't get the care that doesn't enhance their health. and that is where i think it doesn't given the easy solution to the sgr problem but it is a potential for cost savings to eliminate care that does not contribute to people's health. that is an area where dr. weaver was mentioning this dancing data and the power that information is physicians want to get a+ and there are scores so when they

are comparing to one another that is another aspect of professionalism is perfectionism so we need that going forward. >> thank you senator. senator kyla think one of the answers to your question about why is the care not as patient centric as it could need, in the silos of payment, we paid by areas of the country so areas such as are areas in the west and arizona have lower payment rates for the same service. there are differentials on the site of service. the same service in a different setting. a hospital physician offices paid far differently. if we have the payment that follows the patient, that would do a lot in terms of how we focus on that care and i think breaking down some of those silos so that the money can follow where the patient is best treated, will allo